title: Disaster nephrology: crush injury and beyond.
abstract: Disasters result in a substantial number of renal challenges, either by the creation of crush injury in victims trapped in collapsed buildings or by the destruction of existing dialysis facilities, leaving chronic dialysis patients without access to their dialysis units, medications, or medical care. Over the past two decades, lessons have been learned from the response to a number of major natural disasters that have impacted significantly on crush-related acute kidney injury and chronic dialysis patients. In this paper we review the pathophysiology and treatment of the crush syndrome, as summarized in recent clinical recommendations for the management of crush syndrome. The importance of early fluid resuscitation in preventing acute kidney injury is stressed, logistic difficulties in disaster conditions are described, and the need for an implementation of a renal disaster relief preparedness program is underlined. The role of the Renal Disaster Relief Task Force in providing emergency disaster relief and the logistical support required is outlined. In addition, the importance of detailed education of chronic dialysis patients and renal unit staff in the advance planning for such disasters and the impact of displacement by disasters of chronic dialysis patients are discussed.
authors.affiliation: Faculty of Medicine and Dentistry, Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: R T Noel
authors.initials: RT
authors.lastname: Gibney
authors.affiliation: Renal Disaster Relief Task Force (RDRTF) for Turkey, Department of Internal Medicine/Nephrology, Istanbul School of Medicine, Istanbul, Turkey.
authors.forename: Mehmet S
authors.initials: MS
authors.lastname: Sever
authors.affiliation: 1] Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN), Department of Internal Medicine/Nephrology, University Hospital, Ghent, Belgium [2] Renal Division, Department of Internal Medicine, University Hospital, Ghent, Belgium.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Vanholder
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D003444:Crush Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D004189:Disaster Planning / Q000458:organization & administration; D004630:Emergencies; D005440:Fluid Therapy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D054527:Mass Casualty Incidents; D009398:Nephrology / Q000379:methods* / Q000458:organization & administration; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome